The law does not care — now, neither do I

Since about 1987, my position on the age-old debate about Fire versus Private or Third-Service EMS has unambiguously and unapologetically favored the latter. To say otherwise would be nothing short of gargantuan hypocrisy.

Over the years I have welcomed, if not provoked, boisterous debate on the subject with anyone willing to engage. Using words like “greedy,” “egotistical,” “obtuse,” and “devious,” I condemned the devolution of ALS into a function of the fire service – done at the expense of providers whose sole focus is the delivery of quality medical care and the patients they could have served. I have warned of the inherent dangers in placing such responsibility in the hands of firefighters who are distracted by non-medical diversions or, worse yet, who have been drafted against their will into a paramedic program.

I have been steadfast in my convictions for 20-some years — until now.

Since I began speaking to EMS providers about the law and how to protect themselves, the majority of my audiences have been from the fire service. As a guest lecturer at UCLA/DFH Paramedic School, the students I teach mostly represent area fire departments. I have had countless one-on-one discussions with fire department paramedics and paramedic candidates, yet I only recently realized something that I should have seen long ago.

A few months ago, I spoke at the Kentucky State EMS Conference. Between sessions, I was discussing the local EMS delivery system with a veteran non-fire department paramedic. I posed the question: Fire or Private, which is the superior delivery system?

His answer was so simple, so obvious that it made the question seem superfluous: “It doesn’t matter.”

He said any EMS system can only be measured one provider at a time. In the end, the delivery system is nothing more than a means of transportation. It is the commitment and dedication of the individual provider that matters. If a provider doesn’t want to be there, it doesn’t matter what the patch on their arm says; the patient suffers either way.

Since that conversation, I have addressed hundreds of EMS providers, discussing the perils and pitfalls of the job as it relates to legal entanglements. I have had countless interactions with fire department paramedics — opportunities to talk about law, EMS, and current and future changes. In each of those interactions, I considered my conversation in Kentucky as a sort of template to interpret some “bigger picture” meaning, to get some insight into what kind of provider they are.

The age-old and ongoing battle between Fire and Private EMS is the wrong battle. If there must be a battle over quality patient care ... it should be between providers who are committed to their duties and dedicated to the best possible patient care, and those who are not. That is the only fight that the law truly cares about.

— David Givot

The Kentucky paramedic was 100 percent right. EMS is not the expression of the sum of its parts, EMS is the individual parts. Each provider is EMS and, like the law, EMS doesn’t care how you get to the scene; EMS only cares about what you do when you get there.

A fire department paramedic who only went through training because of the pay increase is just as dangerous as the private paramedic who hates his job and his employer for paying so little. The dedicated, committed private paramedic who joins a fire department for a more secure future should be no less engaged than the same dedicated paramedic who doesn’t follow that path. The age-old and ongoing battle between Fire and Private (or Third service) EMS is the wrong battle. If there must be a battle over quality patient care — and there must be — it should be between providers who are committed to their duties and dedicated to the best possible patient care, and those who are not. That is the only fight that the law truly cares about.

The greatest challenge now is convincing providers and provider agencies to look closely at themselves and make the determination of where they fit. To recognize that reputations are built or shattered; that families are preserved or decimated; that lives are either saved or lost — one provider at a time. Like the law, there is no “halfway” consideration in EMS.

As a paramedic, my study and understanding of the law has cast an ultra-bright light on just how much the two have in common. It is an understanding of the law that brings clarity to what it means to be an EMS provider. Both require judgments based on facts and likelihoods before committing to a course of action.

EMS and the law are very much alike. Both seem to expand and contract; adapt and evolve as the needs and expectations change; and separate what works from what does not. Each are defined by the progress of generations, and are identified by the foibles of those whose focus are diverted by other distractions.

Ultimately, both share a common goal: to make better the world it serves. EMS and the law are only as strong as those individuals who deliver it.